STUDENT KATHERINE OSTBYE MPH 2009 PRECEPTOR CAROLINE FICHTENBERG, PHD
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1 Baltimore City Health Department Unintentional Injury Mortality Needs Assessment STUDENT KATHERINE OSTBYE MPH 2009 PRECEPTOR CAROLINE FICHTENBERG, PHD
2 Unintentional Injury Mortality Review Maryland Vital Statistics data for Baltimore City, Objectives 1. Characterize Unintentional Injury Mortality for Baltimore City 2. Compare to other deaths 3. Compare to similar, US 4. Identify Unintentional Injury of Need/Importance 5. Identify prevention and monitoring methods
3 What is Unintentional Injury Death? Classifications based on National Center for Vital Statistics and the World Health Organization: WHO ICD-10 codes identify specific underlying cause of death Excludes ICD-10 codes for intentional mortality (e.g. homicide and suicide) Includes: MV Accidents Falls, Fires, Poisoning, etc. Intention must be definitively unintentional (Excludes unknown intent) AKA Accidents preventable deaths.
4 Unintentional Injury Mortality Review ICD-10 Code from death certificate/md VS data Characterization based on demographics Age, Sex and Race Age-adjusted rates Looking for Differences among groups Time trends ( ) Extension to Community Statistical Area analysis
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8 2. Compare UI Mortality to Other Causes of Death 10 Leading Causes of Death for Baltimore City Determining Counts 113 Leading causes of death (adults) 50 Leading causes of death (infants) Unknown ages (n=20) Determining Population Denominators CDC Wonder Population, vintage 2007 (CSA, 2000 Census)
9 Baltimore City Leading Cause of Death by Age Group Rank Total 1 Short gestation (210) Unintentional injuries (37) Unintentional injuries (75) Homicide (831) Homicide (526) HIV/AIDS (986) Heart disease (1,508) Malignant Neoplasms (2,367) Malignant Neoplasms (3,136) Heart disease (4,260) Heart disease (4,192) Heart disease (15,721) 2 SIDS (142) Congenital anomalies (18) Homicide (30) Unintentional injuries (131) HIV/AIDS (216) Heart disease (511) Malignant Neoplasms (1,408) Heart disease (2,145) Heart disease (2,924) Malignant Neoplasms (3,468) Malignant Neoplasms (1,558) Malignant Neoplasms (12,527) 3 Congenital anomalies (92) Homicide (14) Malignant Neoplasms (20) Suicide (54) Heart disease (146) Malignant neoplasm (454) HIV/AIDS (911) Cerebrovascular Disease (366) Diabetes mellitus (519) Cerebrovascular Disease (999) Cerebrovascular Disease (938) Cerebrovascular Disease (3,219) 4 Maternal Complication (57) Malignant Neoplasms (7) Chronic lower respiratory disease (12) Malignant Neoplasm (28) Unintentional injuries (139) Homicide (285) Cerebrovascular Disease (261) Diabetes mellitus (339) Cerebrovascular Disease (495) Chronic lower respiratory disease (717) Chronic lower respiratory disease (481) HIV/AIDS (2,525) 5 Bacterial sepsis (43) Cerebrovascular disease (4) Suicide (11) Heart disease (27) Suicide (86) Unintentional injuries (193) Chronic Liver Disease (238) HIV/AIDS (319) Chronic lower respiratory disease (454) Diabetes mellitus (613) Influenza and pneumonia (444) Chronic lower respiratory disease (2,068) 6 Placenta, cord, membrane (36) Chronic lower respiratory disease (4) Benign neoplasm (5) Chronic lower respiratory disease (13) Malignant Neoplasms (81) Cerebrovascular Disease (131) Septicemia (211) Septicemia (282) Septicemia (387) Septicemia (609) Septicemia (438) Septicemia (2,063) 7 Respiratory distress (36) Heart disease (4) Congenital anomalies (5) HIV/AIDS (13) Septicemia (30) Chronic Liver Disease (103) Unintentional injuries (206) Chronic lower respiratory disease (213) Nephritis, Nephrotic (230) Influenza and pneumonia (392) Alzheimer s disease (403) Diabetes mellitus (2,054) 8 Unintentional injuries (18) Influenza and pneumonia (3) Heart disease (4) Congenital anomalies (10) Diabetes mellitus (19) Suicide (97) Diabetes mellitus (184) Chronic Liver Disease (180) Influenza and pneumonia (195) Nephritis, Nephrotic (306) Diabetes mellitus (316) Homicide (1,903) 9 Homicide (17) Medical complications (2) HIV/AIDS (3) Legal Intervention (10) Cerebrovascular Disease (18) Septicemia (91) Influenza and pneumonia (136) Unintentional injuries (168) Unintentional injuries (160) Unintentional injuries (211) Nephritis, nephritic (229) Unintentional injuries (1,459) 10 Perinatal period (17) Suicide (2) Septicemia (2) Septicemia (8) Chronic lower respiratory disease (17) Influenza and pneumonia (75) Nephritis, nephritic (123) Nephritis, nephritic (165) Hypertension (120) Alzheimer s disease (203) Hypertension (193) Influenza and pneumonia (1,391)
10 Baltimore City Leading Cause of Death by Sex Men Women Leading Causes of Death N Leading Causes of Death N Heart disease 7,680 Heart disease 8,048 Malignant neoplasm 6,317 Malignant neoplasm 6,210 Homicide 1,706 Cerebrovascular disease 1,878 HIV/AIDS 1,678 Diabetes mellitus 1,174 Cerebrovascular disease 1,341 Chronic lower respiratory disease 1,171 Unintentional injuries 972 Septicemia 1,117 Septicemia 947 HIV/AIDS 847 Chronic lower respiratory disease 897 Influenza and Pneumonia 693 Diabetes mellitus 880 Nephritis 595 Influenza and Pneumonia 699 Unintentional injuries 489
11 Baltimore City Leading Cause of Death by Race African Americans Whites Leading Causes of Death N Leading Causes of Death N Heart disease 9,162 Heart disease 6,479 Malignant neoplasm 7,726 Malignant neoplasm 4,734 HIV/AIDS 2,347 Cerebrovascular disease 1,215 Cerebrovascular disease 1,986 Chronic lower respiratory disease 1,157 Homicide 1,783 Septicemia 697 Diabetes mellitus 1,440 Influenza and Pneumonia 619 Septicemia 1,357 Diabetes mellitus 601 Unintentional injuries 923 Unintentional injuries 518 Chronic lower respiratory disease 905 Alzheimer's disease 353 Nephritis 840 Chronic liver disease 293
12 3. Comparison to Other Cities, US DC, NYC, Pittsburgh, Detroit Data collected from respective HD websites Age-adjusted rates used when available Created crude rates with CDC Wonder populations if only N s were provided Overall, Baltimore has a lower rate of Unintentional Injury mortality than comparable cities (except for NYC) Baltimore and the state of Maryland have lower rates of Unintentional Injury mortality than the United States
13 Unintentional Injury Mortality Rates Location Baltimore City New York City 2006 Philadelphia Pittsburgh 2000 Wayne County (Detroit) 2006 D.C Maryland New York U.S * Crude rate Rate per 100,000 per year * 38.6*
14 4. Identify Unintentional Injury of Need/Importance Utilized the CDC NCHS ICE ICD-10 Matrix for Injury Mortality Characterize UI Subgroups Age-adjusted rates Counts by age group Characterize Falls
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16 5 Leading Unintentional Injury Mortalities by Age Group, Baltimore City, Rank Total 1 Suffocation 14 Fire 16 All Transport 32 All Transport 97 All Transport 92 All Transport 85 All Transport 71 Fall 49 Fall 52 Fall 106 Fall 65 All Transport Fire 3 All Transport 9 Fire 24 Fire 10 Fire 15 Fall 28 Fall 43 All Transport 46 All Transport 37 All Transport 31 Suffocation 27 Fall Natural/ Environmental 1 Drowning 5 Drowning 11 Drowning 8 Poisoning 7 Poisoning 26 Fire 20 Fire 20 Fire 18 Suffocation 27 All Transport 31 Fire Suffocation 4 Poisoning 3 Poisoning 5 Fall 5 Fire 15 Poisoning 18 Natural/ Environmental 15 Suffocation 12 Unspecified 13 Unspecified 13 Suffocation 99 5 Fall 3 Unspecified 2 Fall 3 Drowning 4 Drowning 11 Natural/ Environmental 16 Unspecified 9 Natural/ Environmental 9 Natural/ Environmental 11 Fire 9 Poisoning 83
17 Leading Unintentional Injury Deaths by Injury Type Baltimore City,
18 Fall Mortality Rates Age-adjusted Fall Mortality Rate Per 100,000/yr Baltimore City New York City 2006 D.C Maryland New York U.S
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23 CSA Map Rates per 100,000 population, shaded by quintiles. Potential to identify high risk areas. Healthy Homes CARE
24 Prevention & Monitoring Why are falls increasing, and what can be done to prevent them? Why is difficult to answer because the rates are increasing across nearly all of the population demographics, despite noticeable gaps between population subgroups. High incidence + High susceptibility to injury Prevention will have to focus on all races, both sexes, and all ages >55 years. Prevention Identification of Organizations in contact with this age group Healthy Homes CARE Identification of intervention techniques
25 Prevention & Monitoring Psychosocial Support & Healthy Aging 1 : Beneficial effects on health behaviors Preventing poor diet, medication misuse, physical inactivity, and social isolation Research shows that detection and amelioration of risk factors can significantly reduce the rate of future falls. Other evidence-based fall reduction methods include systematic exercise programs and environmental inspection and improvement programs. 2 1 Peel et al. Ann. N.Y. Acad. Sci. 1114: (2007). 2 Rubenstein LZ. Age and Ageing 2006; 35-S2: ii37 ii41
26 Thank You Alisa Ames, MHS Baltimore City Health Department PHASE & JHSPH
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